On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced an unprecedented partnership between private and public healthcare insurance organizations focused on fighting healthcare fraud.
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The Antikickback statute is a law that seeks to regulate the financial relationships between physicians and/or other provider entities where there is a possibility of patient referrals for items or services reimbursable by a Federal health care program. In this, it is much like the Stark Law, about which we wrote in the past. The New York State Medicaid Program recognizes that certain Medicaid enrollees are not able to use mass transit or other forms of transportation to get to and from a doctor’s appointment and “[i]f the enrollee cannot get to medical services, then the Program fails from the start.” To that end, Medicaid covers the least costly, The New York State Medicaid transportation program has undergone some changes recently. In January, the New York State Department of Health announced that a contract was awarded to LogistiCare Solutions to manage the transportation needs of Medicaid enrollees. Each New York City borough will be brought under the management of the contractor in phases. Among the many rules physicians must comply with are the rules pertaining to advertisement of physician services. The federal self-referral law, often referred to as the Stark Law, prohibits a physician from referring patients to receive “designated health services” (DHS) payable by Medicare or Medicaid to an entity with which the physician or an immediate family member has a financial relationship. See 42 U.S.C. §1395nn. The New York State’s Office of the Medicaid Inspector General (OMIG) recently released the agency’s 2012-2013 workplan. The agency’s focus remains firmly on fighting fraud, waste and abuse, compliance and self-disclosure, and provider education. We look closer at how the OMIG plan impacts pharmacy and durable medical equipment (DME) businesses. In the workplan released earlier in the week, the New York State Office of the Medicaid Inspector General (OMIG), which is an independent agency within the Department of Health, renewed its commitment to fighting fraud, waste and abuse in the New York Medicaid Program. One of the nine business lines that the agency will focus The New York Medicaid Program pays costs of all emergency ambulance and medically necessary non-emergency transportation, as well as the necessary transportation expenses for Medicaid enrollees who must travel an extraordinary distance to receive medical care. The New York Medicaid Program will only reimburse transportation providers if specific records verifying an occurrence of a trip are maintained for each leg of the trip. The New York State Medicaid Program announced in its official publication that the NY Medicaid program will no longer cover certain treatments for chronic low back pain. The New Jersey Medicaid and New Jersey FamilyCare programs insures more than one million New Jersey residents. Review responsibilities of the different units within the Medicaid Fraud Division, the State’s “watchdog” agency over these programs. Yesterday the Department of Health and Human Services announced a proposed rule that would delay the implementation of the International Classification of Diseases, 10th Edition, diagnosis and procedure code (ICD-10) from October 1, 2013 to October 1, 2014. The proposed rule is in response to providers’ concerns about meeting HHS’ compliance deadline for Version 5010 The Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and Most healthcare providers are aware of the need to comply with the Occupational Health And Safety Act (OSHA) to assure, so far as possible, safe and healthful working conditions for their office staff. Here is a quick checklist of the annual OSHA requirement: In the fall of last year, the Office of Inspector General (OIG) for the Department of Health & Human Services (HHS) released its Fiscal Year 2012 workplan which identifies new and already-in progress programs of focus for the OIG. While the doctor is busy treating patients, the patients may be busy documenting the doctor on camera. In this day and age when virtually every cell phone and tablet contains a video or photo camera, it is simpler than one might think. There is a compelling reason for doctors to appeal Medicare audit for overpayments. If a New York doctor accepts Medicaid and practices in New York that may be enough be included an audit program conducted through a project known as Payment Error Rate Measurement Program (PERM). Most physician employment contracts contain a non-compete clause as a condition of employment. It is easy to overlook, but it places limits on a doctor’s ability to find future work or practice in a location of choice and therefore should be carefully considered. While referral fees is a common practice for many businesses, it’s a big no-no when it comes to the practice of medicine in New York and physicians may be staring down professional misconduct charges if they cross the line. Many laws and regulations speak to this issue. |
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